Pittsburgh Knee Rules
Defines when knee x-rays are unnecessary, based on the Pittsburgh rules.
When to Use
The Pittsburgh decision rules can be applied to all patients with an acute knee injury in the past 1 week old, without prior knee surgery or ED evaluation.
- The Pittsburgh knee rules were derived to aid in the efficient use of radiography in acute knee injuries.
- Found in most studies to have a higher specificity than the Ottawa Knee Rule, which would mean fewer x-rays would be needed, while maintaining a sensitivity close to 100%.
- Not useful in children under age 12 as all these patients would require x-rays by the Pittsburgh decision rules.
- The Pittsburgh decision rules are not as well validated as the Ottawa Knee Rule with fewer external validation studies.
- Patients without criteria for imaging by the Pittsburgh decision rules are highly unlikely to have a fracture and do not need plain radiographs.
- It has a higher specificity than the Ottawa Knee Rule, reducing the number of false positives.
- Application of the Pittsburgh decision rules can cut down on the number of unnecessary radiographs by up to 78%.